CONTEMPORARY MENTAL HEALTH WEEK 4. MODELS OF MENTAL HEALTHC. H.docx

CONTEMPORARY MENTAL HEALTH WEEK 4. MODELS OF
MENTAL HEALTH
C. HEPWORTH 2018 19
AIMS AND OBJECTIVES
LINKS TO:
L O 1 AND 2 (LINKS TO PART 2 OF ASSIGNMENT)
RECAP LAST WEEK
LIST THE SIGNS AND SYMPTOMS OF:
PTSD
DEPRESSION
SCHIZOPHRENIA
THIS WEEK….
1. MODELS OF MENTAL HEALTH –BIO-MEDICAL
MODELAND INTERVENTIONS
AIM:
TO CONSIDER THE DIFFERING APPROACHES TO MENTAL
HEALTH AND HOW THIS INFLUENCES TREATMENT
OBJECTIVES:
CONSIDER THE BIOMEDICAL MODEL
OUTLINE THE SOCIAL MODEL OF MENTLA HEALTH

MODELS
BIO-MEDICAL MODEL
MENTAL ILLNESS IS A DYSFUNCTION
LABELLED
LINKED PHYSIOLOGICAL PROBLEMS
CHEMICAL IMBALANCES IN THE BRAIN
“TREATED” BY MEDICAL INTERVENTION (MORE NEXT
WEEK)
OUTCOME AND AIM IS TO ALLEVIATE THESE
“CHEMICAL IMBALANCES”AND HELP CONTROL THUS
CONTROL SYMPTOMS
THIS MODEL ALSO EMPHASISED BY DRUG COMPANIES
“IMBALANCES OF CERTAIN CHEMICALS IN THE BRAIN
ARE THOUGHT TO LEAD TO SYSMPTOMS OF THE
ILNESS.MEDICINE PLAYS A KEY ROLE INBALANCING
THESE CHEMICALS” (DRUG COMPANY WEBSITE PFIZER
2006)
GLAXO-SMITH-KLEIN (2009) “PROZAC AND PRAZIL
BALANCE YOUR BRAIN’S CHEMISTRY”
AMERICA PSYCHIATRIC ASSOCIATION 1996
TREATMENT FOR SCHIZOPHRENIA WITH
ANTIPSYCHOTIC DRUGS “HELPS BRING BIOCHEMICAL
IMBALANCES CLOSER TO NORMAL”
DISEASE CENTRE MODEL

MONCREIFF (2013) DESCRIBES THE DISEASE CENTRE
MODEL IN MENTAL HEALTH (DERIVES FROM
BIOMEDICAL MODEL)
DRUGS CORRECT ABNORMAL BRAIN STATE
DRUGS AS MEDICAL TREATMENT
THEY ARE EFFECTIVE
SIDE EFFECTS LESS IMPORTANT
TREATMENT ASSUMNES A DISEASE PROCESS
DRUGS MAKE THE BODY “NORMAL”
E.G. MANY ANTIPSYCHOTIC DRUGS BLOCK THE
ACTIONS OF DOPAMINE
BUT….
DRUGS INTOXIFY THE BRAIN (NOT JUST ALCOHOL)
NO EVIDENCE THEY WORK TO REVERSE DISEASE
DUBROVSKY ET AL 2001
NO EVIDENCE THAT DEPRESSION IS ASSOCIATED WITH
ABNORMALITIES OF SEROTONIN OR NORADRENLAINE
AS ONCE THROUGHT
DOPAMINE HYPOTHESIS IN SCHIZOPHRENIA “IS NOT
CONLUSIVE” (MOORCREIF)
ELECTRO-CONVULSIVE THERAPY (ECT)
LINKED TO THE BIO-MEDICAL AND DISEASE MODEL OF
MENTAL HEALTH
GIVEN UNDER GENERAL ANAESTHETIC
CAUSES A SEIZURE (DELIBERATELY)
THOUGHT TO CHANGE THE CHEMICAL IMBALANCE OF
THE BRAIN ASSOCIATED WITH:
SEVERE DEPRESSION
SEVERE MANIA
POST NATAL DEPRESSION (MIND 2017)
https://www.youtube.com/watch?v=9L2-B-aluCE

SIDE EFFECTS
MEMORY LOSS
APATHY
CONFUSION
INABILITY TO PROCESS INFORMATION
PSYCHOSURGERY
PREVALENT UP THE 1960’S
FRONTAL LOBE LOBOTOMY
TREATMENT NOT WORKING
? SOCIAL CONTROL??
https://www.youtube.com/watch?v=nJAaXttDIWA
USED IN THE PAST
INSULIN THERAPY FOR DEPRESSION
INDUCED HYPO (LOW BLOOD SUGAR)
What effect on a person can a label have??
TREATMENT….
STIGMA
GOFFMAN – READING…

STIGMA - A PSYCHIATRIST’S VIEW…. A TED
TALK…(20 MINS)
https://www.youtube.com/watch?v=WrbTbB9tTtA
What should be done?
https://www.youtube.com/watch?v=fs4PgfHUmnw
RECAP
RECAP
ASSIGNMENT QUESTIONS
NEXT WEEK :
STRUCTURE OF MENTAL HEALTH SERVICES IN THE UK

REFERENCES
DUBOVSKY, S.l. ET AL (2001) “MOOD DISORDERS” IN:
HALES,R.E. AND YUDOFSKY,S.C. 9EDS) TEXTBOK OF
CLINICAL PSYCHIATRY .WASHINGTON D.C. AMERICAN
PSYCHIATRIC ASSOCIATION
MOORCREIFF, J (2013) THE BITTEREST PILLS. LONDON:
PALGRAVE MACMILLAN
CONTEMPORARY MENTAL HEALTH WEEK 5 CHRISSIE
HEPWORTH
MODELS OF MENTAL HEALTH AND INTERVENTION:
PSYCHOLOGICAL
STRUCTURE OF NHS SERVICES 2018 19
AIMS AND OBJECTIVES
AIM
TO CONSIDER EXAMPLES OF INTERVENTIONS USING
THE PSYCHOLOGICAL MODEL OF MENTAL HEALTH
TO OVERVIEW THE STRUCTURE OF THE NHS (LINKED
WITH STUDENT DIRECTED LEARNING ON MENTAL
HEALTH SERVICES AND DEVO MANC GIVEN LAST
WEEK)
OBJECTIVES
BY THE END OF THIS SESSION STUDENTS WILL BE ABLE
TO:
OUTLINE RELEVANT PSYCHOTHERAPIES USED TO
TREAT COMMON MENTAL HEALTH ISSUES I.E.C.B.T,
PERSON CENTRED,TRANSACTIONAL ANAYSIS.SELF

HELP GOUPS,
OUTLINE CURRENT NHS STRUCTURE AND RELATE THIS
TO SERVICE PROVISION (STUDENT DIRECTED
LEARNING LAST WEEK).
VIEWING MENTAL HEALTH FROM THE PSYCHOLOGICAL
MODEL OF MENTAL HEALTH
LAST WEEK – MODELS OF MENTAL HEALTH –
BIOLOGICAL AND TREATMENTS – MEDICATION
PSYCHOLOGICAL MODEL
SERVICE USER MAY HAVE PROBLEMS OF
DYSFUNCTIONAL COPING SKILLS, SELF ESTEEM,
TRAUMA, SOCIAL SKILLS CAUSED A BY A RANGE OF
TRIGGERS.
LOOK TO ANALYSE AND HELP SU TO DEVELOP A MORE
FUNCTIONAL MINDSET
PSYCHOLOGICAL INTERVENTIONS:
USE CONVERSATIONS AND INTERPERSONAL METHODS
TO SUPPORT SU
TALKING THERAPIES/COUNSELLING
PSYCHOTHERAPY
DIFFERENT TYPES OF THERAPY
TRAINED THERAPISTS – TRAINING,
I.A.P.T – NICE GUIDELINES FOR ALL CMH AND
THERAPEUTIC INTERVENTION
RESEARCH AND EVIDENCE BASED
E.G. SCHIZOPHRENIA – TREATMENT FLOW CHARTS
https://pathways.nice.org.uk/pathways/psychosis-and-
schizophrenia
E.G. DEPRESSION
https://pathways.nice.org.uk/pathways/depression#path=view%3
A/pathways/depression/step-2-recognised-depression-in-adults-
persistent-subthreshold-depressive-symptoms-or-mild-to-

moderate-depression.xml&content=view-index
TYPES OF PSYCHOTHERAPY
PERSON CENTRED (HUMANISM)
MAIN PEOPLE INVOLVED IN DEVELOPING THIS FORM
OF THERAPY:
GERARD EGAN/CARL ROGERS
BASED UPON
GENUINENESS EMPATHY ACCEPTANCE
SEVERAL 50 MUNUTE SESSIONS WITH THERAPIST
LOOK AT SELF AWARENESS AND INCREASING SELF
ACCEPTANCE IN S.U.
DIRECTED SELF DISCOVERY
https://www.youtube.com/watch?v=7PV9Yp34awQ
COGNITIVE BEHAVIOURAL THERAPY (C.B.T.)
COGNITIVE BEHAVIOURAL THERAPY.
MAIN PEOPLE INVOLVED IN DEVELOPING THIS:
PIONEERED BY DR. AARON T. BECK IN THE 1960S (USA)
CHRISTINE PADESKY “MIND OVER MOOD” (2014)
BASED UPON:
CBT MODEL (MODEL DRAW ON BOARD)
N.I.C.E GUIDELINES FOR A RANGE OF CONDITIONS –
ANXIETY AND
DEPRESSION/P.T.S.D./O.C.D./SCHIZOPHRENIA
50M MINUTE SESSIONS 1:1 GROUPS – 6 IN I.A.P. T.
RANGE OF TECHNIQUES E.G. E.R.P. FOR PTSD
QUALIFIED THERAPIST IN C.B.T.

ART THERAPY
ART THERAPY IS:
“is a form of expressive therapy that uses the creative process
of making:
(arthttp://www.arttherapyblog.com/what-is-art-
therapy/#.WeiMg2hSyUl to improve a person’s physical,
mental, and emotional well-being)
N.I.C.E GUIDELINES FOR STRESS/IMPROVE SELF ESTEEM
CAN BE USED BY THERAPISTS/ARTISTS WITH TRAINING
IN MH.
CRITICISMS OF THERAPY
PILGRIM (1997)
PEOPLE CAN CHANGE WITHOUT THERAPY
FEW DIFFERENCES IN APPROACHES BUT DIFFERENCES
IN THERAPISTS
THOSE WHO MOST BENEFIT ARE THOSE WITH POOR
NETWORKS AND POOR SUPPORTIVE RELATIONSHIPS
IT IS THE LISTENING THAT IS THERAPEUTIC!
EXPERIENCE AND TRAINING OF THERAPIST
NOT ALL TECHNIQUES HELPFUL FOR ALL
HOMEWORK
EXPOSURE
FLOODING - NOT ALLOWED IN SOME AGENCIES – (E.G.
ANXIETY U.K.) USED IN CBT
CBT AND OFFENDERS – CAN MAKE OFFENDER WORSE
(NORWAY - WIFE BEATERS)
AGENCY/THERAPIST/I.A.P. T. – TIME FRAME
STRUCTURE OF THE NHS
STRUCTURE OF THE NHS 2017 (SEE ALSO DIRECTED

LEARNING)
https://www.kingsfund.org.uk/audio-video/how-new-nhs-
structured
MENTAL HEALTH
DEPARTMENT OF HEALTH (2000) THE NHS PLAN: A PLAN
FOR INVESTMENT, A PLAN FOR REFORM.
LONDON:DEPARTMENT OF HEALTH
“ONE THOUSAND NEW GRADUATE PRIMARY CARE
MENTAL HEALTH WORKERS,TRAINED IN BRIEF
THERAPY TECHNIQUES OF PROVEN EFFECTIVENESS,
WILL BE EMPLOYEED TO HELP G.P.’S MANAGE AND
TREAT COMMON PROBLEMS IN ALL AGE GROUPS
INCLUDING CHILDREN”. (DH2000:119)
EMPHASES ON PRIMARY CARE FOLLOWING THE NHS
AND COMMUNITY CARE ACT 1990 AND CLOSURE OF
INSTITUTIONS (LESTER AND GLASBY 2010:56)
LOCALITY BASED COMMUNITY MENTAL HEALTH
SERVICES/MULTIDISCIPLINARY TEAMS
SPECIALIST INTERVENTION.
COMMUNITY MENTAL HEALTH SERVICES
SPECIALIST TEAMS
ASSERTIVE OUTREACH TEAM (COMPLEX CARE TEAM)
“… work with people who are over 18 years old who have
ongoing complex mental health needs. And need intensive
support because of mental disability…”
Crisis intervention
violent behaviour,
serious self harming,
not responding to treatment,
drug or alcohol use and mental illness. This is known as dual
diagnosis, or
unstable accommodation or are homeless.

Work with SU’s – crisis plan/support
https://www.rethink.org/diagnosis-treatment/treatment-and-
support/assertive-outreach/what-are-assertive-outreach-teams
CRISIS RESOLUTION/HOME TREATMENT TEAMS
“They aim to assess all patients being considered for acute
hospital admission, to offer intensive home treatment rather
than hospital admission if feasible, and to facilitate early
discharge from hospital. Key features include 24-hour
availability and intensive contact in the community, with visits
twice daily if needed.”
http://apt.rcpsych.org/content/19/2/115
EARLY INTERVENTION SERVICES
E.G. BURY
https://www.penninecare.nhs.uk/your-services/service-
directory/bury/mental-health/adults/bury-early-intervention-
service/
14-35 YEARS WITH EPISODES OF PSYCHOSIS
WORK IN PARTNERSHIP WITH EDUCATION/YOUTH
SERVICES/SOCIAL SERVICES
HELP WITH ASSESSMENT/DIAGNOSES/TREATMENT
FINANCE MANAGEMENT/PHYSICAL HEALTH/HOUSING
ALSO...
DON’T FORGET THE IMPORTANCE OF THE MANY
CHARITIES…MHIST, ADVOCACY TEAMS,CAHMS….SEE
LATER…
ACUTE MENTAL HEALTH SERVICES

GREATER MANCHESTER MENTAL HEALTH FOUNDATION
TRUST
HEAD OFFICE: PRESTWICH
PROVIDES
“We provide mental health treatment, support and guidance for
people of all ages living in Bolton, Salford and Trafford where
we offer day care, in-patient care and community services.
We also provide alcohol and drug services in Salford, Trafford,
Wigan and Leigh, Central Lancashire and Cumbria.
We have a number of specialist regional and national services
including; a unique offender rehabilitation programme, a
National Centre for Mental Health and Deafness, a
Psychotherapy Service, an Eating Disorders Service and one of
the largest young person’s specialist mental health services in
the country”
https://www.nhs.uk/Services/Trusts/Overview/DefaultView.aspx
?id=2601
REGULATION OF MENTAL HEALTH SERVICES IN UK
ACUTE AND COMMUNITY MENTAL HEALTH SERVICES
MONITORED BY THE CARE QUALITY COMMISSION
E.G.
THE STATE OF MENTAL HEALTH SERVICES 2014-2017
http://www.cqc.org.uk/publications/major-report/state-care-
mental-health-services-2014-2017
RECAP
REFERENCES (see also links on slides)
ANXIETY UK https://www.anxietyuk.org.uk/
GREENBERGER, D AND PADESKY, C (2014) MIND OVER

MOOD. LONDON: MACMILLAN
EGAN, G (1993) THE SKILLED HELPER. COLE
PUBLISHING
PILGRIM, D (1997) PSYCHOTHERAPY AND SOCIETY.
LONDON:SAGE
www.depressionalliance.org
www.iapt.nhs.uk
www.beating the blues.co.uk
N.I.C.E GUIDELINES FOR THERAPY
https://www.nice.org.uk/guidance/cg178/ifp/chapter/psychologi
cal-therapy
Structure of the NHS 2017
file:///M:/courses/Community%20Studies%20From%20Backup/
MODULES/Contemporary%20Mental%20Health%202017%2018
HLT6060A/Week%205/NHS%20Structure_2016.pdf%20kings%
20Fund.pdf
Preventing suicide in
England
A cross-government outcomes strategy to save lives
2

DH INFORMATION READER BOX
Policy Clinical Estates
HR / Workforce Commissioner Development IM & T
Management Provider Development Finance
Planning / Performance Improvement and Efficiency Social
Care / Partnership Working
Document Purpose Best Practice Guidance
Gateway Reference 17680
Title Preventing suicide in England: A cross-government
outcomes strategy
to save lives
Author HMG / DH
Publication Date 10 September 2012
Target Audience PCT Cluster CEs, NHS Trust CEs, SHA
Cluster CEs, Care Trust CEs,
Foundation Trust CEs , Medical Directors, Directors of PH,
Directors of
Nursing, Local Authority CEs, Directors of Adult SSs, PCT
Cluster
Chairs, NHS Trust Board Chairs, Special HA CEs, Directors of
HR,
Directors of Finance, Allied Health Professionals, GPs,
Communications Leads, Emergency Care Leads, Directors of
Children's SSs, Youth offending services, Police, NOMS and
wider
criminal justice system, Coroners, Royal Colleges, Transport
bodies

Circulation List Voluntary Organisations/NDPBs
Description A new strategy intended to reduce the suicide rate
and improve support
for those affected by suicide. The strategy: sets out key areas
for
action; states what government departments will do to
contribute; and
brings together knowledge about groups at higher risk, effective
interventions and resources to support local action.
Cross Ref No Health Without Mental Health: A Cross-
Government Mental Health
Outcomes Strategy for People of all Ages
Superseded Docs
National Suicide Prevention Strategy for England
Action Required
N/A
Timing N/A
Contact Details Mental Health and Disability Division
Department of Health
133-155 Waterloo Road
London
SE1 8UG
020 7972 1332
www.dh.gov.uk/
For Recipient's Use

Preventing suicide in
England
A cross-government outcomes strategy to save lives
Prepared by Department of Health
You may re-use the text of this document (not including logos)
free of charge in any format
or medium, under the terms of the Open Government Licence.
To view this licence, visit
www.nationalarchives.gov.uk/doc/open-government-licence/
© Crown copyright 2011
First published September 2012
Published to DH website, in electronic PDF format only.
www.dh.gov.uk/publications

http://www.nationalarchives.gov.uk/doc/open-government-
licence/
http://www.dh.gov.uk/publications
2
Ministerial Foreword
In England, one person dies every two
hours as a result of suicide. When
someone takes their own life, the effect on
their family and friends is devastating.
Many others involved in providing support
and care will feel the impact.
In developing this new national all-age
suicide prevention strategy for England,
we have built on the successes of the
earlier strategy published in 2002. Real
progress has been made in reducing the
already relatively low suicide rate to record
low levels.
But there is no room for complacency.
There are new challenges that need to be
addressed. And at a time when we have
economic pressures on the general
population, it is particularly timely to revisit
a national strategy that has demonstrated
clear progress.
If we are to continue to prevent suicide, we
also need to take specific actions, as
outlined in this strategy.

This strategy supports action by bringing
together knowledge about groups at higher
risk of suicide, applying evidence of
effective interventions and highlighting
resources available. This will support local
decision-making, while recognising the
autonomy of local organisations to decide
what works in their area.
The factors leading to someone taking
their own life are complex. No one
organisation is able to directly influence
them all. Commitment across
government, from Health, Education,
Justice and the Home Office, Transport,
Work and Pensions and others will be
vital. We also need the support of the
voluntary and statutory sectors, academic
institutions and schools, businesses,
industry, journalists and other media. And,
perhaps above all, we must involve
communities and individuals whose lives
have been affected by the suicide of
family, friends, neighbours or colleagues.
We have made it clear that mental and
physical health have to be seen as equally
important. For suicide prevention, this will
mean effectively managing the mental
health aspects, as well as any physical
injuries, when people who have self-
harmed come to A&E. It will also mean
having an effective 24 hour response to
mental health crises, as well as for
physical health emergencies.

The strategy has been developed with the
support of leading experts in the field of
suicide prevention, including the members
of the National Suicide Prevention
Strategy Advisory Group, under the
chairmanship of Professor Louis Appleby.
I would like to thank all members of this
group for sharing their knowledge and
expertise with us. Their continued support
and leadership is central to our efforts to
prevent suicides in England.
Norman Lamb MP
Minister of State for Care Services
3
Contents
Ministerial
Foreword.................................................................................
.................................. 2
Contents
...............................................................................................
..................................... 3
Preface
...............................................................................................
....................................... 4
Executive summary
...............................................................................................

.................... 5
Introduction
....................................................................................... ........
................................. 9
1. Area for action 1: Reduce the risk of suicide in key high-risk
groups ................................ 13
2. Area for action 2: Tailor approaches to improve mental health
in specific groups ............ 21
3. Area for action 3: Reduce access to the means of suicide
............................................... 35
4. Area for action 4: Provide better information and support to
those bereaved or affected
by suicide
...............................................................................................
.................................. 39
5. Area for action 5: Support the media in delivering sensitive
approaches to suicide and
suicidal behaviour
...............................................................................................
..................... 43
6. Area for action 6: Support research, data collection and
monitoring ................................ 47
7. Making it happen locally and nationally
............................................................................ 50
References
...............................................................................................
............................... 54
Preventing suicide in England
4

Preface
Suicide is often the end point of a complex
history of risk factors and distressing
events; the prevention of suicide has to
address this complexity. This strategy is
intended to provide an approach to suicide
prevention that recognises the
contributions that can be made across all
sectors of our society. It draws on local
experience, research evidence and the
expertise of the National Suicide
Prevention Strategy Advisory Group, some
of whom have experienced the tragedy of
a suicide within their families.
In fact, one of the main changes from the
previous strategy is the greater
prominence of measures to support
families (action 4) – those who are worried
that a loved one is at risk and those who
are having to cope with the aftermath of a
suicide. The strategy also makes more
explicit reference to the importance of
primary care in preventing suicide and to
the need for preventive steps for each age
group.
In identifying the high-risk groups who are
priorities for prevention (action 1), we have
selected only those whose suicide rates
can be monitored – this is essential if we
are to report on what the strategy
achieves. However, there are also other
groups for whom a tailored approach to
their mental health is necessary if their risk

is to be reduced (action 2). These are
groups who may not be at high risk overall,
such as children, or whose risk is hard to
measure or monitor, such as minority
ethnic communities. We have highlighted
the importance of tackling certain methods
of suicide (action 3) and of working with
the media towards sensitive reporting in
this area (action 5). We have stressed the
need for timely data collection and high-
quality research (action 6).
We have also had to be clear about the
scope of the strategy. It is specifically
about the prevention of suicide rather than
the related problem of non-fatal self-harm.
Although people with a history of self-harm
are identified as a high risk group, we have
not tried to cover the causes and care of
all self-harm. Similarly, whether the law on
encouraging or assisting suicide should be
changed is a separate issue, outside the
scope of the strategy.
No health without mental health, published
in 2011, is the government’s mental health
strategy. An implementation framework
has also been published, to set out what
local organisations can do to turn the
strategy into reality, what national
organisations are doing to support this,
and how progress will be measured and
reported. This is vital, because suicide
prevention starts with better mental health
for all - therefore this strategy has to be

read alongside that implementation
framework.
The inclusion of suicide as an indicator
within the Public Health Outcomes
Framework will help to track national
progress against our overall objective to
reduce the suicide rate.
The strategy is intended to be up to date,
wide-ranging and ambitious. Its publication
marks the beginning of a new drive to
reduce further the avoidable toll of suicide
in England.
Professor Louis Appleby CBE
Department of Health, Chair of the
National Suicide Prevention Strategy
Advisory Group
5
Executive summary
1. Suicide1 is a major issue for society
and a leading cause of years of life
lost. Suicides are not inevitable. There
are many ways in which services,
communities, individuals and society as
a whole can help to prevent suicides
and it is these that are set out in this
strategy.

Objectives and areas for action
2. This strategy sets out our overall
objectives:
• a reduction in the suicide rate in the
general population in England; and
• better support for those bereaved or
affected by suicide.
3. We have identified six key areas for
action to support delivery of these
objectives:
1: Reduce the risk of suicide in key
high-risk groups
2: Tailor approaches to improve mental
health in specific groups
3: Reduce access to the means of
suicide
4: Provide better information and
support to those bereaved or affected
by suicide
5: Support the media in delivering
sensitive approaches to suicide and
suicidal behaviour

6: Support research, data collection
and monitoring.
1 Suicide is used in this document to mean a
deliberate act that intentionally ends one’s life.
Reduce the risk of suicide in key high-risk
groups
4. We have identified the following high-
risk groups who are priorities for
prevention:
• young and middle-aged men
• people in the care of mental health
services, including inpatients
• people with a history of self-harm
• people in contact with the criminal
justice system
• specific occupational groups, such as
doctors, nurses, veterinary workers,
farmers and agricultural workers.
5. Those who work with men in different
settings, especially primary care, need
to be particularly alert to the signs of
suicidal behaviour.
6. Treating mental and physical health as
equally important in the context of
suicide prevention will have

implications for the management of
care for people who self-harm, and for
effective 24 hour responses to mental
health crises.
7. Accessible, high-quality mental health
services are fundamental to reducing
the suicide risk in people of all ages
with mental health problems.
8. Emergency departments and primary
care have important roles in the care of
people who self-harm, with a focus on
good communication and follow-up.
9. Continuing to improve mental health
outcomes for people in contact with the
criminal justice system will contribute to
suicide prevention, as will ongoing
delivery of safer custody.
10. Suicide risk by occupational groups
may vary nationally and even locally,
6
and it is vital that the statutory sector
and local agencies are alert to this, and
adapt their suicide prevention
interventions accordingly.
Tailor approaches to improve mental

health in specific groups
11. Improving the mental health of the
population as a whole is another way to
reduce suicide. The measures set out
in both No health without mental health
and Healthy Lives, Healthy People will
support a general reduction in suicides.
12. This strategy identifies the following
groups for whom a tailored approach to
their mental health is necessary if their
suicide risk is to be reduced:
• children and young people, including
those who are vulnerable such as
looked after children, care leavers and
children and young people in the youth
justice system;
• survivors of abuse or violence,
including sexual abuse;
• veterans;
• people living with long-term physical
health conditions;
• people with untreated depression;
• people who are especially vulnerable
due to social and economic
circumstances;
• people who misuse drugs or alcohol;
• lesbian, gay, bisexual and transgender

people; and
• Black, Asian and minority ethnic groups
and asylum seekers.
13. Children and young people have an
important place in this strategy.
Schools, social care and the youth
justice system, as well as charities
highlighting problems such as bullying,
low body image and lack of self-
esteem, all have an important
contribution to make to suicide
prevention among children and young
people. Measures to help parents
keep their children safe online are
included in area for action 5. The call
for research to support the strategy
includes a focus on children and young
people and self-harm.
14. Timely identification and referral of
women and children experiencing
abuse or violence, so that they are able
to benefit from appropriate support, is
of course a positive step in its own
right, as well as helping to reduce
suicide risk.
15. The Government is committed to
improving mental health support for
service and ex-service personnel
through the Military Covenant.

16. In No health without mental health we
made it clear that we expect parity of
esteem between mental and physical
health. Routine assessment for
depression as part of personalised care
planning for people with long-term
conditions, can help reduce inequalities
and help people to have a better quality
of life.
17. Depression is one of the most
important risk factors for suicide. The
early identification and prompt,
effective treatment of depression has a
major role to play in preventing suicide
across the whole population.
18. Given the links between mental ill-
health and social factors like
unemployment, debt, social isolation,
family breakdown and bereavement,
the ability of front-line agencies to
identify and support (or signpost to
support) people who may be at risk of
developing mental health problems is
important for suicide prevention.
19. Measures that reduce alcohol and drug
dependence are critical to reducing
suicide.
7

20. Staff in health and care services,
education and the voluntary sector
need to be aware of the higher rates of
mental distress, substance misuse,
suicidal behaviour or ideation and
increased risks of self-harm amongst
lesbian, gay and bisexual people, as
well as transgender people.
21. Community initiatives can be effective
in bridging the gap between statutory
services and Black, Asian and minority
ethnic communities, and in tackling
inequalities in health and access to
services.
Reduce access to the means of suicide
22. One of the most effective ways to
prevent suicide is to reduce access to
high-lethality means of suicide. Suicide
methods most amenable to intervention
are:
• hanging and strangulation in
psychiatric inpatient and criminal
justice settings;
• self-poisoning;
• those in high-risk locations; and
• those on the rail and underground
networks.
23. Continued vigilance by mental health

service providers will help to identify
and remove potential ligature points.
Safer cells complement care for at-risk
prisoners.
24. Safe prescribing can help to restrict
access to some toxic drugs.
25. Local agencies can prevent loss of life
when they work together to discourage
suicides at high-risk locations. Local
authority planning departments and
developers can include suicide in
health and safety considerations when
designing structures which may offer
suicide opportunities.
26. British Transport Police, London
Underground Limited, Network Rail,
Samaritans and partners are working to
reduce suicides on the rail and
underground networks.
Provide better information and support to
those bereaved or affected by suicide
27. Every suicide affects families, friends,
colleagues and others. Suicide can
also have a profound effect on the local
community. It is important to:
• provide effective and timely support for
families bereaved or affected by
suicide;
• have in place effective local responses

to the aftermath of a suicide; and
• provide information and support for
families, friends and colleagues who
are concerned about someone who
may be at risk of suicide.
28. Effective and timely emotional and
practical support for families bereaved
by suicide is essential to help the
grieving process and support recovery.
It is important the GPs are vigilant to
the potential vulnerability of family
members when someone takes their
own life.
29. Post-suicide community-level
interventions can help to prevent
copycat and suicide clusters. This
approach may be adapted for use in
schools, workplaces, health and care
settings.
30. It is important that people concerned
that someone may be at risk of suicide
can get information and support as
soon as possible. For individuals
already under the care of health or
social services, family, carers and
friends should know who to contact and
be appropriately involved in any care
planning. Help is available through
many outlets across the statutory and

8
voluntary sector for people who are not
known to services.
Support the media in delivering sensitive
approaches to suicide and suicidal
behaviour
31. The media have a significant influence
on behaviour and attitudes. We want
to support them by:
• promoting the responsible reporting
and portrayal of suicide and suicidal
behaviour in the media; and
• continuing to support the internet
industry to remove content that
encourages suicide and provide ready
access to suicide prevention services.
32. Local, regional and national
newspapers and other media outlets
can provide information about sources
of support when reporting suicide.
They can also follow the Press
Complaints Commission Editors’ Code
of Practice and Editors’ Codebook
recommendations regarding reporting
suicide.

33. The Government will continue to work
with the internet industry through the
UK Council for Child Internet Safety to
create a safer online environment for
children and young people.
Recognising concern about misuse of
the internet to promote suicide and
suicide methods, we will be pressing to
ensure that parents have the tools to
ensure that their children are not
accessing harmful suicide-related
content online.
Support research, data collection and
monitoring
34. The Department of Health will continue
to support high-quality research on
suicide, suicide prevention and self-
harm through the National Institute for
Health Research and the Policy
Research Programme.
35. Reliable, timely and accurate suicide
statistics are essential to suicide
prevention. We will consider how to
get the most out of existing data
sources and options to address the
current information gaps around
ethnicity and sexual orientation.
36. Reflecting the continuing focus on
suicide prevention, the Public Health
Outcomes Framework includes the
suicide rate as an indicator.

Making it happen – locally and nationally
37. Much of the planning and work to
prevent suicides will be carried out
locally. The strategy outlines evidence
based local approaches and national
actions to support these local
approaches.
38. Local responsibility for coordinating
and implementing work on suicide
prevention will become, from April
2013, an integral part of local
authorities’ new responsibilities for
leading on local public health and
health improvement.
39. It will be for local agencies, including
working through health and wellbeing
boards to decide the best way to
achieve the overall aim of reducing the
suicide rate. Interventions and good
practice examples are included to
support local implementation. Many of
them are already being implemented
locally but local commissioners will be
able to select from or adapt these
suggestions based on the needs and
priorities in their local area.
40. An implementation framework for No
health without mental health has
recently been published. The
framework explicitly covers suicide
prevention, and supports
implementation of this strategy.

9
Introduction
1. Suicide is a major issue for society.
The number of people who take their
own lives in England has reduced in
recent years. But still, over 4,200
people took their own life in 2010.
2. Every suicide is both an individual
tragedy and a terrible loss to society.
Every suicide affects a number of
people directly and often many others
indirectly. The impact of suicide can be
devastating – economically,
psychologically and spiritually – for all
those affected.
3. Suicides are not inevitable. An
inclusive society that avoids the
marginalisation of individuals and
which supports people at times of
personal crisis will help to prevent
suicides. Government and statutory
services have a role to play. We can
build individual and community
resilience. We can ensure that
vulnerable people in the care of health
and social services and at risk of
suicide are supported and kept safe

from preventable harm. We can also
ensure that we intervene quickly when
someone is in distress or in crisis.
4. Most people who take their own lives
have not been in touch with mental
health services. There are many things
we can do in our communities, outside
hospital and care settings, to help
those who think suicide is the only
option.
5. Between July and October 2011, the
Government held a public consultation
on a new suicide prevention strategy
for England. A summary of the
consultation responses that were
received, and the decisions that the
Government has taken in the light of
them is available from
www.dh.gov.uk/health/category/publications/consult
ations/consultation-responses/
The challenge of suicide prevention
6. The likelihood of a person taking their own
life depends on several factors. These
include:
• gender – males are three times as
likely to take their own life as females;
• age – people aged 35-49 now have the
highest suicide rate;

• mental illness;
• the treatment and care they receive
after making a suicide attempt;
• physically disabling or painful illnesses
including chronic pain; and
• alcohol and drug misuse.
7. Stressful life events can also play a part.
These include:
• the loss of a job;
• debt;
• living alone, becoming socially
excluded or isolated;
• bereavement;
• family breakdown and conflict including
divorce and family mental health
problems; and
• imprisonment.
For many people, it is the combination of
factors which is important rather than one
single factor. Stigma, prejudice,
harassment and bullying can all contribute
to increasing an individual’s vulnerability to
suicide.
8. Several research studies have looked at
risk factors for suicide in different groups.
In 2008 the Scottish Government Social

Research Department undertook a
Literature Review: Risk and Protective
Factors for Suicide and Suicidal Behaviour
www.scotland.gov.uk/Publications/2008/11/28141444/0.
This review describes and assesses
10
knowledge about the societal and
cultural factors associated with
increased incidence of suicide (risk
factors) and also the factors that
promote resilience against suicidal
behaviour (protective factors).
9. Suicide rates in England have been at
a historical low recently and are low in
comparison to those of most other
European countries. In England in
2008-10, the mortality rate from suicide
was 12.2 deaths per 100,000
population for males and 3.7 deaths for
females.1 The latest 15-year trend in
the mortality rate from suicide and
injury of undetermined intent using
three-year pooled rates is shown in
Figure 1.
Figure 1: Death rates from intentional self-
harm and injury of undetermined intent,
England 1994-2010

0
2
4
6
8
10
12
1994-1996 1996-1998 1998-2000 2000-2002 2002-2004 2004-
2006 2006-2008 2008-2010
Three-year average
Age standardised death rate per 100,000 population
Source: ONS
10. The past couple of years have seen a
slight increase in suicide rates, but the
2008-10 rate remains one of the lowest
rates in recent years. There has been
a sustained reduction in the rate of
suicide in young men under the age of
35, reversing the upward trend since
the problem of suicides in this group
first escalated over 30 years ago. We
have also seen significant reductions in
inpatient suicides and self-inflicted
deaths in prison. A statistical update is
being published alongside this strategy
document.

11. However, we know from experience that
suicide rates can be volatile as new risks
emerge. The recent slight increase in the
suicide rate in 2008-10 demonstrates the
need for continuing vigilance and why,
despite relatively low rates, a new suicide
prevention strategy for England is needed.
12. Previously, periods of high unemployment
or severe economic problems have had an
adverse effect on the mental health of the
population and have been associated with
higher rates of suicide.2 Evidence is
emerging of an impact of the current
recession on suicides in affected
countries.3 However, suicide risk is
complex and for many people it is a
combination of factors, outlined above, that
determines risk rather than any single
factor.
13. This suicide prevention strategy can help
us reduce further the rates of suicide in
England and respond positively to the
challenges we will face over the coming
years.
Objectives and priorities
14. Our overall objectives are:
• a reduction in the suicide rate in the
general population in England; and
• better support for those bereaved or

affected by suicide.
15. We have identified six areas for action to
support delivery of these objectives which
each have a chapter of this strategy
devoted to them.
16. Much of the planning and work to prevent
suicides will be carried out locally. The
strategy outlines a range of evidence
based local approaches. National actions
to support these local approaches are also
detailed for each of the six areas for action.
17. Interventions and good practice examples
are included to support local
implementation and are not compulsory.
11
Many of them are already being
implemented locally but local
commissioners will be able to select
from and adapt these suggestions
based on their assessment of the
needs and agreement of the priorities
in their local area.
18. We should always use cost-effective
evidence-based approaches which
work as early as possible. This is

above all in the best interests of service
users - and also enables the care
services to make best use of limited
resources. This means getting it right
first time - improving outcomes and
preventing problems from getting
worse to avoid the need for more
expensive interventions later on.
19. We need to tackle all the factors which
may increase the risk of suicide in the
communities where they occur if our
efforts are to be effective. Suicide
prevention is most effective when it is
combined as part of wider work
addressing the social and other
determinants of poor health, wellbeing
or illness.
Outcomes strategies and making an
impact
20. Cross-cutting outcomes strategies
recognise that the Government can
achieve more in partnership with others
than it can alone, and that services can
achieve more through integrated
working than they can through working
in isolation from one another. This new
approach builds on existing joint
working across central government
departments, and between the
Government, local government, local
organisations, employers, service
users and professional groups, by
unlocking the creativity and innovation

suppressed by a top-down approach.
21. There are two other key strategy
documents that, in combination with this
one, take a public health approach using
general and targeted measures to improve
mental health and wellbeing and reduce
suicides across the whole population.
22. Healthy Lives, Healthy People: Our
strategy for public health in England (2010)
gives a new, enhanced role to local
government and local partnerships in
delivering improved public health
outcomes. Local responsibility for
coordinating and implementing work on
suicide prevention will become, from April
2013, an integral part of local authorities’
new responsibilities for leading on local
public health and health improvement.
The prompts for local councillors on
suicide prevention published alongside this
strategy are designed as helpful pointers
for how local work on suicide prevention
can be taken forward.
23. Health and wellbeing boards will support
effective local partnerships and will be able
to support suicide prevention as they
determine local needs and assets.
24. Public Health England, the new national
agency for public health, will also support
local authorities, the NHS and their
partners across England to achieve
improved outcomes for the public’s health

and wellbeing, including work on suicide
prevention.
25. No health without mental health: A cross-
government outcomes strategy for people
of all ages (2011) is key in supporting
reductions in suicide amongst the general
population as well as those under the care
of mental health services. The first agreed
objective of No health without mental
health aims to ensure that more people will
have good mental health. To achieve this,
we need to:
• improve the mental wellbeing of
individuals, families and the population
in general;
12
• ensure that fewer people of all ages
and backgrounds develop mental
health problems; and
• continue to work to reduce the
national suicide rate.
26. No health without mental health
includes new measures to develop
individual resilience from birth through
the life course, and build population
resilience and social connectedness

within communities. These too are
powerful suicide prevention measures.
27. The stigma associated with mental
health problems can act as a barrier to
people seeking and accessing the help
that they need, increasing isolation and
suicide risk. The Government is
supporting the national mental health
anti-stigma and discrimination Time to
Change programme.
28. An implementation framework for No
health without mental health was
published in July 2012. This sets out
what local organisations can do to
implement the mental health strategy,
what work is underway nationally to
support them, and how progress
against the strategy’s aims will be
measured. The framework explicitly
covers suicide prevention, and
supports implementation of this new
suicide prevention strategy so should
be read alongside this document.
29. During the development of this suicide
prevention strategy, Samaritans have
been facilitating a Call to Action for
Suicide Prevention in England. The Call to
Action consists of national organisations
from across sectors in England taking
action so that fewer lives are lost to suicide
and people bereaved or affected by a
suicide receive the right support.

30. Member organisations have signed a
declaration on suicide prevention for
England; mapped existing suicide
reduction and support activity in their
organisations and identified priorities for
joint action.
31. We are publishing separately an
assessment of the impact on equalities of
this strategy.
32. Our approach in this strategy is to:
• set out clear, shared objectives for suicide
prevention, and key areas where action is
needed;
• state what government departments will do
to contribute to these objectives;
• set out how the outcomes frameworks for
public health and the NHS will require
reductions in the suicide rate; and
• support effective local action by bringing
together knowledge about groups at higher
risk of suicide, evidence around effective
interventions and highlighting research
available.

13
1. Area for action 1: Reduce the risk of
suicide in key high-risk groups
1.1 Some groups of people are known to
be at higher risk of suicide than the
general population. We have been
able to identify these groups from
research and can monitor numbers
from the routine data collected. In this
way we identified:
• those groups that are known
statistically to have an increased risk
of suicide; and
• actual numbers of suicides in these
groups.
1.2 In addition, evidence already exists on
which to base preventative measures
in these groups. We are also able to
monitor the impact of preventative
measures taken using existing data
collections.
1.3 The groups at high risk of suicide are:

• young and middle-aged men;
• people in the care of mental health
services, including inpatients;
• people with a history of self-harm;
• people in contact with the criminal
justice system;
• specific occupational groups, such as
doctors, nurses, veterinary workers,
farmers and agricultural workers.
1.4 There are other groups whose risk
could be high, but limits on the data
available mean that their risk is hard to
estimate, or else there is no way of
monitoring progress as a result of
suicide prevention measures.
1.5 Although the strategy focuses on
groups at higher risk, it recognises
that individuals may fall into two or
more high-risk groups. Conversely,
not all individuals in the groups will be
vulnerable to suicide.
Young and middle-aged men
• Men are at three times greater risk of
suicide than women. Most suicides

are among men aged under 50. Men
aged 35-49 are now the group with the
highest suicide rate.
• Older men (over 75) also have higher
rates of death by suicide, which may
reflect the impact of depression, social
isolation, bereavement or physical
illness.
• Factors associated with suicide in men
include depression, especially when it
is untreated or undiagnosed; alcohol
or drug misuse; unemployment; family
and relationship problems including
marital breakup and divorce; social
isolation and low self-esteem.45
1.6 Men aged under 35 were a high-risk
group in the 2002 strategy. Although the
suicide rate in men aged under 35 has
fallen we are continuing to highlight
young men within the strategy because
suicide is the single most frequent cause
of death, and their youth means that it
accounts for a large number of years of
life lost. This does not mean that older
men should be overlooked. Rates of
suicide in men aged over 75 remain
high. Different risk factors, such as

loneliness and physical illness, may be
important in this age group.
Effective local interventions
1.7 Findings from three mental health
promotion pilot projects launched in 2006
14
to address the raised suicide risk in
young men show that:
• multi-agency partnership is key to
promoting young men’s mental health;
• community locations, such as job
centres and young people-friendly
venues, are more successful in
engaging with young men than more
formal health settings such as GP
surgeries;
• front-line staff feel better able to
engage with young men if they receive
training; and
• community outreach programmes are
seen by young men as more

acceptable and approachable than
services provided in formal healthcare
settings.
1.8 We believe that this broad-based
approach has improved the
identification of risk by front-line
agencies and contributed to the
reduction in suicides in the younger
male age group. These findings can
be adapted and applied to all age
groups. Reaching Out, the evaluation
report of the three projects is available
at www.nmhdu.org.uk/nmhdu/en/our-
work/promoting-wellbeing-and-public-mental-
health/suicide-prevention-resources/
1.9 Many statutory and third sector
organisations have set up regional
and local initiatives and projects to
support men and encourage them to
contact services when they are in
distress. Some of these projects take
their messages out into traditional
male territories, such as football and
rugby clubs, leisure centres, public
houses and music venues.
National action to support local approaches
1.10 Samaritans has launched a five-year

campaign to address suicide in men in
mid-life of lower socio-economic
position. This includes research to
understand why this group is at
excessive risk of dying by suicide
compared to other groups, stimulating
debate about policy and practice to
reduce suicide in this group, and
encouraging men to contact Samaritans.
Helpful resources
NHS Hull has produced a short fictional
film to help men in the city understand
depression and its effect on their lives.
‘Peter’s Story’ aims to encourage men,
particularly in the 25–50 age group, to think
and talk about issues with their mental
health and wellbeing. www.peters-story.co.uk
The Men’s Health Forum has published
Untold Problems: a review of the essential
issues in the mental health of men and
boys and a good practice guide, Delivering
Male: Effective practice in male mental
health, setting out ways to improve men’s
health, including strategies to prevent
suicide and encourage help-seeking.
People in the care of mental health services,
including inpatients

Patient safety in the mental health services
continues to improve.
• The number of people in contact with
mental health services who died by
suicide has reduced from 1,253 in 2000
to an estimated 1,187 in 2010, a
reduction of 66 deaths (5%)
• The number of inpatients who died by
suicide reduced from 196 in 2000 to 74
in 2010, a reduction of 122 deaths
(62%). The number of inpatients who
died on wards by hanging or
strangulation reduced by 54%
• The number of patients who refused
http://www.nmhdu.org.uk/nmhdu/en/our-work/promoting-
wellbeing-and-public-mental-health/suicide-prevention-
resources/
resources/
resources/
http://www.peters-story.co.uk/
15
drug treatment who died by suicide

reduced from 229 in 2000 to 141 in
2010 (38%). www.medicine.manchester.
ac.uk/mentalhealth/research/suicide/
• People with severe mental illness
remain at high risk of suicide, both
while in inpatient units and in the
community. Inpatients and people
recently discharged from hospital and
those who refuse treatment are at
highest risk.
1.11 The provision of high-quality services
that are equally accessible to all is
fundamental to reducing the suicide
risk in people of all ages with mental
health problems.
1.12 Although much has been achieved by
front-line staff to reduce suicides in
people with mental health problems,
they remain a group at high risk, so it
is important that mental health
services remain vigilant and continue
to strengthen clinical practice.
1.13 The National Confidential Inquiry into

Suicide and Homicide by People with
Mental Illness (NCI) checklist ‘Twelve
Points to a Safer Service’ is based on
recommendations from a national
study of patient suicides and provides
key guidance for mental health
services.
www.medicine.manchester.ac.uk/cmhr/centref
orsuicideprevention/nci/saferservices
1.14 A recent research study suggested
that these services changes
(particularly 24 hour crisis teams,
policies for people with drug and
alcohol problems, and reviews after
suicide) were associated with a
reduction in the rate of suicide in
implementing NHS Trusts.6
1.15 Approaches identified by the NCI which
can contribute to a reduction in suicide
rates include:
• improving care pathways between
emergency departments, primary and
secondary care, inpatient and community
care, and on hospital discharge;
• ensuring that front-line staff working with
high-risk groups receive training in the
recognition, assessment and

management of risk and fully understand
their roles and responsibilities;
• regular assessments of ward areas to
identify and remove potential risks, i.e.
ligatures and ligature points, access to
medications, access to windows and
high-risk areas (gardens, bathrooms and
balconies). The most common ligature
points are doors and windows; the most
common ligatures are belts, shoelaces,
sheets and towels. Inpatient suicide
using non-collapsible rails is a ‘Never
Event’.7* New kinds of ligatures and
ligature points are always being found,
so ward staff need to be constantly
vigilant to potential risk;8
• improving safety in new models of care
such as crisis resolution/home treatment;
• service initiatives to prevent patients
going missing from inpatient wards, such
as those in Strategies to Reduce Missing
Patients: A practical workbook (National
Mental Health Development Unit, 2009);
• good risk management and continuity of
care. The recent judgment, Rabone vs
Pennine Care NHS Foundation Trust,
confirmed that NHS Trusts have a duty

to protect voluntary mental health
patients from the risk of suicide, and
* Never Events are serious, largely preventable, patient safety
incidents that should not occur if the available preventative
measures have been implemented by healthcare providers.
16
highlights the importance of risk
management. Aligning care planning
more closely with risk assessment and
risk management is important, as is
the provision of regular training and
updates for staff in risk management.
The Department of Health guidance
on assessment and management of
risk9 emphasises that risk assessment
should be an integral part of clinical
assessment, not a separate activity.
All service users and their carers
should be given a copy of their care
plan, including crisis plans and contact
numbers;
• innovative approaches which may be
helpful: many local services have
developed ways to follow up people
recently discharged from mental
health inpatient units using telephone,

text messaging and email, as well as
letters.
Helpful resources
1.16 No health without mental health:
Delivering better mental health
outcomes for people of all ages
outlines a range of evidence-based
treatments and interventions to
prevent people of all ages from
developing mental health problems
where possible, intervene early when
they do, and develop and support
speedy and sustained recovery.
www.dh.gov.uk/en/Publicationsandstatistics/P
ublications/PublicationsPolicyAndGuidance/D
H_123737
1.17 NCI provides regular reports on
patient suicides and up-to-date
statistical data. These reports highlight
and make recommendations where
clinical practice and service delivery
can be improved to prevent suicide
and reduce risk.
www.medicine.manchester.ac.uk/suicidepreve
ntion/nci
1.18 The National Patient Safety Agency's
(NPSA’s) Preventing Suicide: A toolkit
for mental health services includes

measures for services to assess how
well they are meeting the best practice
on suicide prevention.
www.nrls.npsa.nhs.uk/resources/?EntryId45=652
97. The NPSA also published Preventing
suicide: A toolkit for community mental
health (2011). It focuses on improving
care pathways and follow up for people
who present at emergency departments
following self-harm or suicidal behaviour
and those who present at GP surgeries
and are identified as at risk of self-harm
or suicide.
www.nhsconfed.org/Documents/Preventing-
suicide-toolkit-for-community-mental-health.pdf
People with a history of self-harm
• There are around 200,000 episodes of
self-harm that present to hospital
services each year.10 However, many
people who self-harm do not seek help
from health or other services and so are
not recorded.
• Studies have shown that by age 15-16,
7-14% of adolescents will have self-
harmed once in their life.11
• People who self-harm are at increased
risk of suicide, although many people

do not intend to take their own life when
they self-harm.12 At least half of people
who take their own life have a history of
self-harm, and one in four have been
treated in hospital for self-harm in the
preceding year. Around one in 100
people who self-harm take their own life
within the following year. Risk is
particularly increased in those repeating
self-harm and in those who have used
violent/dangerous methods of self-
harm.13
http://www.medicine.manchester.ac.uk/suicideprevention/nci
http://www.medicine.manchester.ac.uk/suicideprevention/nci
http://www.nrls.npsa.nhs.uk/resources/?EntryId45=65297
http://www.nrls.npsa.nhs.uk/resources/?EntryId45=65297
http://www.nhsconfed.org/Documents/Preventing-suicide-
toolkit-for-community-mental-health.pdf
http://www.nhsconfed.org/Documents/Preventing-suicide-
toolkit-for-community-mental-health.pdf
17
1.19 Emergency departments have an
important role in treating and
managing people who have self-

harmed or have made a suicide
attempt. There are still problems in
some places with the quality of care,
assessment and follow-up of people
who seek help from emergency
departments after self-harming.14
Attitudes towards and knowledge of
self-harm among general hospital staff
can be poor. A high proportion of
people who self-harm are not given a
psychological assessment. Often,
follow-up and treatment are not
provided, in particular for people who
repeatedly self-harm. In many
emergency departments, the facilities
available for distressed patients could
be improved.
1.20 GPs have a key role in the care of
people who self-harm. Good
communication between secondary
and primary care is vital, as many
people who present at emergency
departments following an episode of
self-harm consult their GP soon
afterwards.15
1.21 Work undertaken by the London
School of Economics has shown that
suicide prevention education for GPs
can have an impact as a population-
level intervention to prevent suicide.
This has the potential to be cost-

effective if it leads to adequate
subsequent treatment. See
www2.lse.ac.uk/businessAndConsultancy/LS
EEnterprise/news/2011/healthstrategy.aspx
1.22 Appropriate training on suicide and
self-harm should be available for staff
working in schools and colleges,
emergency departments, other
emergency services, primary care,
care environments and the criminal
and youth justice systems.
Helpful resources
1.23 Clinicians can use the NICE self-harm
pathway, which summarises both short
and long term self-harm guidance using
a flowchart based approach:
www.pathways.nice.org.uk/pathways/self-harm
1.24 NICE has developed two sets of clinical
practice guidelines on self-harm for the
NHS in England, Wales and Northern
Ireland:
• on the short-term management and
secondary prevention of self-harm in
primary and secondary care (see
http://publications.nice.org.uk/self-harm-

cg16); and
• on the longer-term management of
self-harm. It includes
recommendations for the appropriate
treatment for any underlying
problems (including diagnosed
mental health problems). It also
covers the longer-term management
of self-harm in a range of settings
(see http://publications.nice.org.uk/self-
harm-longer-term-management-cg133).
1.25 The National CAMHS Support Service
produced a self-harm in children and
young people handbook and an e-
learning package, to provide basic
knowledge and awareness of self-harm
in children and young people, with
advice about ways staff in children’s
services can respond.
www.chimat.org.uk/resource/view.aspx?RID=105
602
1.26 NICE quality standards are under
development on self-harm in adults and
children and young people.

1.27 The Royal College of GPs will focus on
strengthening training in mental health
as part of the GP training programme,
http://www.chimat.org.uk/resource/view.aspx?RID=105602
http://www.chimat.org.uk/resource/view.aspx?RID=105602
18
both within current arrangements and
as they develop the case for
enhanced (four year) training.
People in contact with the criminal justice
system
• People at all stages within the CJS,
including people on remand and
recently discharged from custody, are
at high risk of suicide. The period of
greatest risk is the first week of
imprisonment.16 However, recent
figures suggest that risk of self-inflicted
death has decreased in the first week of
custody (Ministry of Justice, Safety in
Custody Statistics).
• Reasons for the increased risk include
the following:

- a high proportion of offenders are
young men, who are already a high
suicide risk group. However, the
increase in suicide risk for women
prisoners is greater than for men;
- an estimated 90% of all prisoners
have a diagnosable mental health
problem (including personality
disorder) and/or substance misuse
problems; and
- offenders can be separated from their
family and friends, whose social
support may help to guard against
suicidal feelings.
• The three-year average annual rate of
self-inflicted deaths* by prisoners in
England was 69 deaths per 100,000
prisoners in 2009-2011. This has
decreased year-on-year since 2004
when it was 132 deaths per 100,000
prisoners.
* Prisoner ‘self-inflicted deaths’ include all deaths
where it appears that a prisoner has acted
specifically to take their own life. Approximately 80
per cent of these deaths receive a suicide or open
verdict at inquest. The remainder receive an
accidental or misadventure verdict.

1.28 Details of proposals to improve mental
health outcomes for people in contact
with the CJS are given in No health
without Mental Health: Delivering better
mental health outcomes for people of all
ages.
www.dh.gov.uk/en/Publicationsandstatistics/Publi
cations/PublicationsPolicyAndGuidance/DH_123
737
1.29 The National Offender Management
Service (NOMS) has a broad, integrated
and evidence-based strategy17 for
suicide prevention and self-harm
management, and is committed to
reducing the number of self-inflicted
deaths in prison custody. The Youth
Justice Board is taking a similar
approach to reduce the number of self-
inflicted deaths in the Young Person’s
Secure Estate. Each death is
investigated by the Prisons and
Probation Ombudsman.
1.30 The National Safer Custody Managers
and Learning Team was established in
2009. The National Safer Custody

Managers provide deputy directors of
custody with advice on safer custody
policies and other areas where they have
a direct link to the delivery of safer
custody. Strenuous efforts are made to
learn from each death and improve
understanding of and procedures for
caring for prisoners at risk of suicide or
self-harm.
1.31 Since the introduction of mental health
in-reach services, the Integrated Drug
Treatment System and Assessment,
Care in Custody and Teamwork
procedures into prisons there has been a
reduction in self-inflicted deaths in prison
custody.
19
1.32 The Department of Health, NOMS and
University of Oxford Centre for Suicide
Research are funding an analysis of
all self-harm data based on incidents
from 2004 to 2009. This will inform
the development of more effective
ways of identifying, managing and
reducing the risk of those prisoners

who self-harm.
1.33 The Health and Criminal Justice
Transition Programme Board is
overseeing a programme to provide
police custody suites and criminal
courts with access to liaison and
diversion services by 2014. These
services will be open and accessible
to people of all ages, whether they
have a mental health problem,
learning disability, personality
disorder, substance misuse issue or
other vulnerability. They will provide
early identification of individuals, allow
the police and courts to understand as
much as possible about the individual,
and inform offender management and
rehabilitation. For people in the
criminal justice system with mental
health needs, the aim is to ensure that
they receive treatment in the most
appropriate setting, whether in prison,
secure mental health services, or in
the community.
1.34 A study commissioned by the
Independent Police Complaints
Commission found that deaths in or
following police custody, particularly
those as a result of hanging, reduced
significantly between 1998-99 and

2008-09. The study report identified
improvements in cell design,
identification of ligature points, risk
assessments and Safer Detention
guidance as all possibly contributing to
the reduction.
www.ipcc.gov.uk/Pages/deathscustodystudy.aspx
Specific occupational groups, such as doctors,
nurses, veterinary workers, farmers and
agricultural workers
• Some occupational groups are at
particularly high suicide risk. Nurses,
doctors, farmers, and other
agricultural workers are at highest
risk, probably because they have
ready access to the means of suicide
and know how to use them.
• Research18 shows that these patterns
of suicide are broadly unchanged.
Among men, health professionals and
agricultural workers remain the
groups at highest risk of suicide.
However, other occupational groups
have emerged with raised risks. The
highest numbers (not rates) of male
suicides were among construction
workers and plant and machine
operatives.
• Among women, health workers, in

particular doctors and nurses,
remained at highest suicide risk.
1.35 This strategy maintains the focus on the
highest risk occupational groups but
recognises the potential vulnerability of
other occupational groups.
1.36 Risk by occupational group may vary
regionally and even locally. It is vital that
the statutory sector and local agencies
are alert to this and adapt their suicide
prevention interventions and strategies
accordingly. For example, GPs in rural
areas, aware of the high rates of suicide
in farmers and agricultural workers, will
be well prepared to assess and manage
depression and suicide risk.
The Practitioner Health Programme, funded
by London primary care trusts, offers a
free, confidential service for doctors and
http://webmail.tiscali.co.uk/cp/ps/Mail/ExternalURLProxy?d=ti
scali.co.uk&u=susanoconnor&url=http://www.ipcc.gov.uk/Pages
/deathscustodystudy.aspx&urlHash=-6.706665258590723E13

20
dentists who live or work in the London
area. www.php.nhs.uk/what-to-expect/how-can-i-
access-php
MedNet is funded by the London Deanery
and provides doctors and dentists working
in the area with practical advice about their
career, emotional support and, where
appropriate, access to brief or longer-term
psychotherapy.
www.londondeanery.ac.uk/var/support-for-
doctors/MedNet
Helpful resources
1.37 The Department for Environment,
Food and Rural Affairs has a number
of measures in place to support rural
workers aimed at easing some of the
stresses which are known to adversely
affect farmers, agricultural workers
and their families. These include
specific support on bovine
tuberculosis to the Farm Crisis
Network. The Task Force on Farming
Regulation aims to reduce some of the
bureaucratic burden on farmers.
Rural Stress Helpline offers a confidential,
non-judgemental listening service to
anyone in a rural area feeling troubled,

anxious, worried, stressed or needing
information. Helpline 0845 094 8286 (Mon-
Fri 9am-5pm); email
[email protected]
1.38 The Department of Health published
Maintaining high professional standards
in the modern NHS (2003) with
additional guidance (2005) on handling
concerns about a practitioner’s health.
3586
1.39 In 2008, The Department of Health
published Mental health and Ill health in
Doctors. This identifies a number of
sources of help and recognises that
many of the issues are very similar for
other health professionals.
066
1.40 NHS Health and Wellbeing Improvement
Framework, published in 2011, is a tool
for decision makers on Boards to support
them in establishing a culture that
promotes staff health and wellbeing.
691

1.41 The Police Service proactively manages
staff wellbeing to try to avoid individuals
becoming unwell due to mental health
problems such as depression, anxiety or
post-traumatic stress disorder. Police
officers and staff can access services
through their line management,
Occupational Health Departments or
often via self-referral.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_4103586
21

2. Area for action 2: Tailor approaches to
improve mental health in specific groups
2.1 As well as targeting high-risk groups,
another way to reduce suicide is to
improve the mental health of the
population as a whole. The
measures set out in both No health
without mental health and Healthy
Lives, Healthy People will support a
general reduction in suicides by
building individual and community
resilience, promoting mental health
and wellbeing and challenging health
inequalities where they exist.
2.2 For this whole population approach to
reach all those who might need it, it
should include tailored measures for
groups with particular vulnerabilities
or problems with access to services.
They are groups of people who may
have higher rates of mental health
problems including self-harm. These
are not discrete groups, and many
individuals may fall into more than
one of these groups, for example,
some Black and minority ethnic
(BME) groups are more likely to have
lower incomes or be unemployed;
children and young people may also
fall into several other of these groups.
The groups identified are:

• children and young people, including
those who are vulnerable such as
looked after children, care leavers
and children and young people in the
YJS;
• survivors of abuse or violence,
including sexual abuse;
• veterans;
• people living with long-term physical
health conditions;
• people with untreated depression;
• people who are especially vulnerable
due to social and economic
circumstances;
• people who misuse drugs or alcohol;
• lesbian, gay, bisexual and
transgender people; and
• Black, Asian and minority ethnic
groups and asylum seekers.
2.3 For many of these groups we do not
have sufficient information about
numbers of suicides or about what
interventions might be helpful. The
requirements for improved
information and research are

considered further under area for
action 6.
Children and young people, including
those who are vulnerable such as looked
after children, care leavers and children
and young people in the YJS
• The suicide rate among teenagers is
below that in the general
population.19 However, young people
are vulnerable to suicidal feelings.
The risk is greater when they have
mental health problems or
behavioural disorders, misuse
substances, have experienced family
breakdown, abuse, neglect or mental
health problems or suicide in the
family. The risk may also increase
when young people identify with
people who have taken their own life,
such as a high-profile celebrity or
another young person.
• Self-harm is particularly common
among young people.20
• Children and young people in the
youth justice system experience
many of the same risk factors as
adults in the criminal justice system.

Since January 2002, six young
22
people in custody in the Young
Person’s Secure Estate have killed
themselves.
• Looked after children and care
leavers are between four and five
times more likely to self-harm in
adulthood. They are also at five-fold
increased risk of all childhood mental,
emotional and behavioural problems
and at six to seven-fold increased
risk of conduct disorders.
2.4 The non-statutory programmes of
study for Personal, Social, Health
and Economic (PSHE) education
provide a framework for schools to
provide age–appropriate teaching on
issues including sex and
relationships, substance misuse and
emotional and mental health. This
and other school-based approaches

may help all children to recognise,
understand, discuss and seek help
earlier for any emerging emotional
and other problems.
2.5 The consensus from research is that
an effective school-based suicide
prevention strategy would include:
• a co-ordinated school response to
people at risk and staff training;
• awareness among staff to help
identify high risk signs or behaviours
(depression, drugs, self-harm) and
protocols on how to respond;
• signposting parents to sources of
information on signs of emotional
problems and risk;
• clear referral routes to specialist
mental health services.
2.6 The Healthy Child Programme 0-19,
led by front line health professionals,
focuses on health promotion,
prevention and early intervention with
vulnerable families. Health visitors

and their teams will identify children
at high risk of emotional and
behavioural problems and ensure
that they and their families receive
appropriate support, including referral
to specialist services where needed.
Preventing suicide in children and
young people is closely linked to
safeguarding and the work of the
Local Safeguarding Children Boards.
Professor Munro’s review of child
protection (2011) made 15
recommendations to reform the
system. The review emphasised the
importance of evidence-based early
interventions and recommended that
help is provided early to children and
families in order to negate the impact
of abuse and neglect and to improve
the life chances of children and
young people. In response, the
Government is working with partners
to reinforce the existing legislation
and revise statutory guidance, and to
understand better how to make
progress on early help. Inspections
of child protection services will
assess local provision of early help.
2.7 Local services can develop systems
for the early identification of children
and young people with mental health
problems in different settings,
including schools. Stepped-care
approaches to treatment, as outlined

in NICE guidance, can be effective
when delivered in settings that are
appropriate and accessible for
children and young people. The
Department of Health’s You’re
Welcome quality criteria self-
assessment toolkit may be helpful in
ensuring that services and settings
are genuinely acceptable and
accessible to children and young
people.
23
2.8 The specialist early intervention in
psychosis model of community care
has achieved better outcomes than
generic community mental health
teams for young people aged 14–35
in the early phase of severe mental
illness, achieving faster and more
lasting recovery. The impact of early
intervention on suicide is under
investigation, but it is clear that
suicide in young patients has
decreased in recent years.21
2.9 It is particularly important that
interventions for children and young

people who offend, and for other
vulnerable children and young people
in the area, are both easily
accessible and engaging. This
requires outreach, flexible
wraparound support and persistence,
so that sessions can continue, even
in the face of barriers to
engagement.22 In all forms of
custodial or secure settings, including
detention, continuous attention is
needed to minimise a young person's
sense of isolation from home and
family and workers should be
proactive in responding to their
mental health needs. What young
people in these circumstances value
highly from professionals is knowing
that someone will listen to them and
be interested in their concerns.
Helpful resources
2.10 Stonewall’s Education for All
campaign, works to tackle
homophobic bullying in Britain’s
schools, and has a lot of resources.
www.stonewall.org.uk/at_school/education_f
or_all/default.asp
2.11 Beatbullying is a UK-wide bullying
prevention charity, and has
developed a large range of anti-

bullying teaching resources to help
raise awareness of bullying in all its
forms and help children to keep safe.
They are available free at:
www.beatbullying.org/dox/resources/resourc
es.html
National action to support local
approaches
2.12 No health without mental health and
No health without mental health:
include local and national
interventions to improve the mental
health of children and young people.
Interventions include effective school-
based approaches to tackling
violence and bullying and sexual
abuse. They also cover effective
approaches to identifying children
who are at risk and the specific
needs of looked after children and
care leavers.
2.13 We are also extending access to
psychological therapies for children
and young people. Building on the
learning from the Improving Access
to Psychological Therapies (IAPT)

initiative for adults, a rolling national
programme with a strong focus on
outcomes will seek to transform local
child and adolescent mental health
services, equipping them to deliver a
broader range of evidence-based
psychological therapies for children
and young people and their families.
2.14 Additional investment will extend both
the geographical reach and range of
therapies offered through the
Children and Young People’s IAPT
project. It will also support
development of interactive e-learning
programmes in child mental health to
extend the skills and knowledge of:
• NHS clinicians;
http://www.stonewall.org.uk/at_school/education_for_all/defaul
t.asp
http://www.stonewall.org.uk/at_school/education_for_all/defaul
t.asp
http://www.beatbullying.org/dox/resources/resources.html
http://www.beatbullying.org/dox/resources/resources.html
24
• a wide range of people working with

children and young people in
universal settings including teachers,
social workers, police and probation
staff and faith group workers;
• school and youth counsellors working
in a range of educational settings.
2.15 The new e-portal will include specific
learning and professional
development in relation to self-harm,
suicide and risk in children and young
people.
2.16 The Children and Young People’s
Health Outcomes Strategy will
identify the health outcomes that
matter most to children, young
people and their families and set out
how the system will contribute to their
delivery. Children and young
people’s mental health outcomes –
including those in relation to suicide
and self-harm – was one of four key
areas considered by the Children and
Young People’s Health Outcomes
Forum. The Forum’s report23,
published in July, and the system’s
response to their recommendations
will be key components within a
Children And Young People’s Health
Outcomes Strategy, which will be

published in autumn 2012.
Survivors of abuse or violence, including
sexual abuse
• One in four people in England has
experienced some form of violence or
abuse in their lifetime, and almost
half of all children have been the
victims of bullying. Women and
children are most at risk of domestic
and sexual violence.
• Violence and abuse can lead to a
number of psychosocial problems
associated with a heightened suicide
risk, including: social isolation and
exclusion; poor educational
achievement; conduct, behavioural
and emotional problems in children,
and antisocial and risk-taking
behaviours. Violence and abuse are
also associated with a higher risk of
mental health problems and suicidal
feelings.
• Adverse and abusive experiences in
childhood are associated with an
increased risk of suicidal behaviour.24

2.17 Timely and effective assessment of
all vulnerable children is crucial to
speedy identification and referral to
appropriate support services.
Screening tools such as the
Strengths and Difficulties
Questionnaire (SDQ) can help to
prioritise referrals to local CAMHS.
2.18 A training and support programme
targeted at primary care clinicians
and administrative staff improved
referral to specialist domestic
violence agencies and recorded
identification of women experiencing
domestic violence.
www.thelancet.com/journals/lancet/article/PII
S0140-6736(11)61179-3/abstract
Leicestershire Police have a
Comprehensive Referral Desk (CRD) of
specialist officers who deal with domestic
abuse, child abuse and adults in
vulnerable situations. Each report from
front-line officers and other agencies is
assessed and dealt with by referral onto
other agencies or by providing an
appropriate police response to any

criminal allegations or safeguarding
issues. The CRD has led to improved joint
working with health and other agencies.
Through partnership working, the CRD
25
tries to reduce the likelihood of the same
individuals being in situations of threat,
harm or risk in the future.
approaches
2.19 Call to End Violence against Women
and Girls (2010), a cross-government
strategy, has been followed by two
cross-government action plans – the
latest of which was published in
March 2012. It includes actions
around preventing violence, provision
of services, partnership working,
justice outcomes and risk reduction.
The Government’s continued support
for Independent Sexual Violence
Advisers, Independent Domestic
Violence Advisers and Multi Agency
Risk Assessment Conferences aims
to ensure that women and girls at
highest risk of violence are identified

and referred for specialist help. Data
sharing between emergency
departments and other agencies is
being encouraged to improve the
identification of violence.
Helpful resources
2.20 The RCGP has produced an e-
learning resource for GPs to enable
them to identify and respond to
victims of domestic violence more
effectively.
www.elearning.rcgp.org.uk/course/view.php?
id=88
2.21 Southall Black Sisters have
developed a model of intervention on
domestic violence amongst Black
and Minority Ethnic women.25
Veterans
• There are five million armed forces
veterans in the UK and around
180,000 serving personnel. The
prevalence of mental disorders in
serving and ex-service personnel is
broadly the same as that in the
general population. Depression and

alcohol abuse are the most common
mental disorders. The most recent
research found that one in four
veterans from the Iraq War
experienced some kind of mental
health problem and one in 20 had
been diagnosed with post-traumatic
stress disorder.
• In general, suicide rates among
armed forces veterans are lower than
those in the general population.
There is no evidence that, as a
whole, people who have served their
country in armed conflict are at
higher risk of suicide. An important
possible exception is young armed-
service leavers in their early 20s.
One study suggests they may be at
two or three times’ greater risk of
suicide than comparable groups.26
outlines all the Government’s
commitments to improving mental
health support for service and ex-
service personnel.
People living with long-term physical

health conditions
• Some long-term conditions are
associated with an increased risk of
suicide, e.g. epilepsy. There is also
evidence that receiving a diagnosis of
cancer, coronary heart disease and
chronic obstructive airways disease
is associated with higher suicide risk.
For cancer, the risk of suicide
increases by more than ten times in
http://www.elearning.rcgp.org.uk/course/view.php?id=88
http://www.elearning.rcgp.org.uk/course/view.php?id=88
26
the week after diagnosis.
• Physical illness is associated with an
increased suicide risk.27 Many
people who live with long-term
conditions - including physical illness,
disability and chronic pain – will, at
some time, experience periods of
depression that may be undiagnosed
and untreated. Disadvantage and
barriers in society for disabled people
can lead to feelings of hopelessness.
People with one long-term condition
are two to three times more likely to

develop depression than the rest of
the general population. People with
three or more conditions are seven
times more likely to have depression.
Many medical treatments for long-
term physical health conditions (for
example, chronic pain medication,
insulin treatment) also provide people
with ready access to the means of
suicide.
• While depression explains a
substantial part of the increased
suicide risk in people with physical
health conditions, it does not explain
all of the increase.
2.23 No health without mental health is
clear that we expect mental health
needs to be given equal
consideration to physical health
needs.
2.24 Support for self-management and
self-care is crucial, for example, in
managing chronic pain, so that
people have a greater sense of
choice over how their health and care
needs are met, feel more confident to

manage their condition on a day-to-
day basis and take an active part in
their care. Feeling in control of one’s
life is associated with increased
mental wellbeing and resilience.
2.25 Routine assessment for depression
as part of personalised care planning
can help reduce inequalities and
support people with long-term
conditions to have a better quality of
life and better social and working
lives.
2.26 Suicide can occur in general
hospitals. Providers need to be
aware of this risk, and to make
appropriate links between physical
and mental health care.
outlines a number of local
approaches to improve the mental
health care of people with physical
health problems.
Helpful resources

2.28 The NPSA has produced suicide
prevention toolkits for ambulance
services, general practice,
emergency departments and
community mental health and mental
health services. The toolkits support
clinicians and managers to
understand what they can do to
reduce the suicides.
www.nhsconfed.org/Publications/briefings/Pa
ges/Preventing-suicide.aspx
approaches
2.29 Talking Therapies: A four year plan of
action (2011) sets out the
Government’s plans to improve
access to talking therapies and
expand provision for children and
young people, older people and their
carers, people with long-term
http://www.nhsconfed.org/Publications/briefings/Pages/Preventi
ng-suicide.aspx
http://www.nhsconfed.org/Publications/briefings/Pages/Preventi
ng-suicide.aspx
27

physical health conditions, people
with medically unexplained
symptoms and people with severe
mental illness.
2.30 The Office for Disability Issues (ODI)
is developing a new cross-
government disability strategy in
partnership with disabled people and
their organisations. Together, they
are identifying effective ways to
remove the barriers that prevent
disabled people, including those with
mental health conditions, from
fulfilling their potential and having
opportunities to play a full role in
society. In September we will publish
a summary of responses to Fulfilling
Potential, including current and
planned actions across government.
We will also outline the next steps
based upon the issues and ideas
disabled people have told us about.
We will publish a strategy and action
plan in 2013.
2.31 The Department of Health’s long-
term conditions model aims to
improve the health and wellbeing of
people with long-term conditions
such as diabetes. The Department is

also developing a Long Term
Conditions Outcomes Strategy for
publication towards the end of 2012
which will outline a vision for how
Government can work with local
bodies to improve outcomes for
people with long-term conditions.
2.32 The Government has recently
published the White Paper Caring for
our future: reforming care and
support28, following extensive
engagement with the care sector
over recent months. This sets out the
Government’s vision for reform of
care and support, with a renewed
focus on high quality, personalised
and joined up care, supporting
people to maintain independence for
as long as possible and have choice
and control over how their outcomes
are met.
People with untreated depression
• Depression is one of the most
important risk factors for suicide and
undiagnosed or untreated depression
can heighten that risk. Most
depression can be treated in primary
care.

• Depression is now recognised as a
major public health problem
worldwide. In England one in six
adults and one in 20 children and
young people at any one time are
affected by depression and related
conditions, such as anxiety.
Depression is the most common
mental health problem in older
people - some 13-16% have
sufficiently severe depression to
need treatment. But only a quarter
(or even fewer young and older
people) receive treatment, even
though effective drug and
psychological treatments are
available.
• Untreated depression can have a
major impact on quality of life and
can cause other health and social
care problems - for example,
postnatal depression can be
associated with behavioural problems
in the child. There are also risks in
the early stages of drug treatment
when some patients feel more
agitated.
• Depression, chronic and painful

physical illnesses, disability,
bereavement and social isolation are
more common among older people.
28
Men aged 75 and over have the
highest rate of suicide among older
people. While suicide rates among
older people have been decreasing in
recent years, an increase in absolute
numbers is expected in the coming
decades, due to the increase in
number of older people.
2.33 People recover more quickly from
depression if it is identified early and
responded to promptly, using
effective and appropriate treatments.
identifies effective local approaches
to treating depression and outlines
some effective approaches for

‘ageing well’.
Helpful resources
2.35 NICE issued updated guidance on
Depression: Management of
depression in primary and secondary
care in 2009 and Depression in
Children and Young People:
Identification and management in
primary, community and secondary
care in 2005. NICE has also
published a quality standard on
depression, including with a chronic
physical health problem.
2.36 Depression Alliance has produced
leaflets on depression and an
information pack.
www.depressionalliance.org
2.37 The Staffordshire University Centre
for Ageing and Mental Health has
developed a set of information sheets
to help health and social care
providers respond to suicide risk in
older clients: www.wmrdc.org.uk/mental-
health/primary-care/suicide-prevention-in-
elders-project-summary

2.38 The Department of Health has
funded multi-centre research on
suicide prevention29 which has
produced useful recommendations
for services working with older
people. It found that older adults who
self-harm are at high risk of suicide,
with men aged over 75 years at
greatest risk. Use of a violent method
in the first attempt is also a predictor
of subsequent suicide. Alcohol
dependency is also common among
older adults who attempt suicide.
2.39 Caring for our future sets out how
supporting active and inclusive
communities, and encouraging
people to use their skills and talents
to build new friendships and
connections, are central elements to
the Government’s new vision for care
and support. The Department of
Health has supported the Campaign
to End Loneliness to produce a digital
toolkit for health and wellbeing
boards to support them in
understanding, and addressing
loneliness and social isolation in their
communities:
www.campaigntoendloneliness.org.uk/toolkit

2.40 The Department of Health, the Royal
Colleges of General Practice,
Nursing and Psychiatry and the
British Psychological Society have
developed a fact sheet on depression
in older people: www.rcgp.org.uk/mental
health/resources.aspx
People who are especially vulnerable due
to social and economic circumstances
http://www.depressionalliance.org/
http://www.rcgp.org.uk/mental%20health/resources.aspx
http://www.rcgp.org.uk/mental%20health/resources.aspx
29
• There are direct links between mental
ill health and social factors such as
unemployment and debt. Both are
risk factors for suicide.
• Previous periods of high
unemployment and/or severe
economic problems have been
accompanied by increased incidence
of mental ill health and higher suicide
rates.30

• Suicide risk is complex – we do need
to be vigilant at this time of higher
economic uncertainty, but it is
important not to assume that an
increase in suicide is inevitable.
• 34% of rough sleepers have a mental
health need and 18% have a mental
health need combined with a
substance misuse issue (dual
diagnosis).
2.41 A range of front-line agencies,
including primary and secondary
health and social care services, local
authorities, the police and Jobcentre
Plus, can identify and support (or
signpost to support) vulnerable
people who may be at risk of suicide.
As the Government's strategy Social
Justice: Transforming Lives also
makes clear, for individuals and
families facing multiple social or
economic disadvantages, it is really
important that these local agencies
'join up' to maximise the
effectiveness of services and

support. www.dwp.gov.uk/docs/social-
justice-transforming-lives.pdf
2.42 Interventions that improve financial
capability reduce both the likelihood
of people getting into debt and the
impact of debt on mental health.
Local services include Citizens
Advice, the Money Advice Service at:
www.moneyadviceservice.org.uk and the
Consumer Credit Counselling
Service: www.cccs.co.uk/Home.aspx.
Credit unions can provide affordable
credit to and encourage saving by the
most disadvantaged families.
2.43 Other useful approaches at a local
level include:
• continuously improving the
knowledge and confidence of front-
line staff who are in regular contact
with people who may be vulnerable
because of social/economic
circumstances. This is particularly
relevant to DWP front-line
businesses including Jobcentre Plus
staff, people working in other advice
and support agencies and front-line
staff in the financial sector (banks,
building societies and utility
companies);

• providing public information to
signpost people to information,
support and useful contacts if they
are in debt or at risk of getting into
debt. Information can be provided in
a number of different ways, for
example online and accessible
leaflets. A number of NHS trusts
have developed information sheets
for the local population on the impact
of the economic crisis - these give
advice on maintaining wellbeing
during difficult times and offer
guidance on where to go for further
help; and
• developing suicide awareness and
education or training programmes to
teach people how to recognise and
respond to the warning signs for
suicide in themselves or in others.
These can be delivered in a variety of
settings (such as schools, colleges,
http://www.moneyadviceservice.org.uk/
http://www.cccs.co.uk/Home.aspx
30
workplaces and job centres). There

are several training programmes
available including Applied Suicide
Intervention Skills Training (ASIST),
Mental Health First Aid, Safe Start
and training carried out by
Samaritans.
2.44 DWP has guidance in place to help
their staff to manage suicide and self-
harm declarations from customers
safely and effectively, for themselves
and the customer.
2.45 Businesses and other employers can
help by investing in and supporting
their staff, particularly during times of
anxiety and change.
approaches
outcomes for people of all ages gives
examples of effective national
approaches to support people back
into employment and improve their
financial capability and to support
employers to meet their business
needs and statutory requirements for
healthy workplaces.

2.47 The Government’s Work Programme
supports people who are out of work
to gain and sustain paid employment.
This includes providing tailored
support for people with mental health
conditions to work. Work Programme
Prime providers and specialist
service providers have pledged to
improve support to people with
mental health problems; an approach
endorsed by voluntary and
community organisations.
2.48 We are replacing a wider range of
financial benefits with a single
Universal Credit which will ensure
that people are always better off in
work. The new system will be much
simpler to administer and easier for
claimants to understand. It will help
people to get back to work gradually
and smooth over earnings
fluctuations where hours of work and
income can vary.
2.49 The Government is committed to
preventing and reducing
homelessness, and improving the
lives of those people who do become

homeless. The Ministerial Working
Group (MWG) on Preventing and
Tackling Homelessness is bringing
the relevant government departments
together to share information, resolve
issues and avoid unintended policy
consequences, with the aim of
enabling communities to tackle the
multifaceted issues that contribute to
homelessness. The MWG produced
its first report A Vision to End Rough
Sleeping: No Second Night Out in
2011 and is working on its second
report on preventing homelessness,
to be published later this year.
www.communities.gov.uk/publications/housi
ng/visionendroughsleeping
People who misuse drugs or alcohol
• Many people with drug and alcohol
dependence problems also have
some form of mental health
problem.3132 Similarly, about half of
people with mental health problems
misuse alcohol and/or drugs. Dual
diagnosis (co-morbidity of drug and
alcohol misuse and mental ill health)
is associated with increased risk of
suicide and suicide attempts.
• The use of drugs or alcohol is

CONTEMPORARY MENTAL HEALTH WEEK 4. MODELS OF MENTAL HEALTHC. H.docx

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